Psoriasis is a chronic inflammatory disease affecting 1% to 3% of the world's population 1,2 and results from the interaction between genetics and environmental factors such as stress, infections, and drugs, causing a T-cell-mediated response. [1][2][3] Vaccination is an uncommon triggering factor for the flare-ups of several skin diseases, 2,4-6 and a potential association between vaccination and the onset or exacerbation of psoriasis has been previously documented. 2,[5][6][7] In this letter, we report four new cases of psoriasis flare-ups after an influenza vaccination (Table 1).The first patient was a 41-year-old man with chronic plaque psoriasis undergoing adalimumab therapy who developed a severe flare-up that required hospital admission 24 hours after an intramuscular Chiroflu influenza vaccination (Trivalent A/Victoria/2452/2019 H1N1, A/Hong Kong/2671/2019 H3N2, and B/Victoria/705/2018) (Figure 1). dGuttate Brodalumab

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